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Franklin County Medicaid Provider Over-Reimbursed $708,998

Tuesday, May 24, 2016

Columbus – Zimam Holdings, LLC, dba Zimam Home Healthcare (Franklin County) provided services with unqualified employees and billed for services before obtaining authorization from a physician, according to an examination released today by Auditor of State Dave Yost.

The examination reviewed a statistical sample of 794 services provided from July 1, 2011 through June 30, 2014 and found 388 errors. Those errors resulted in overpayments totaling $671,678.59 – nearly 42 percent of the total amount reimbursed by the Ohio Department of Medicaid (ODM) during the review period. With interest in the amount of $37,319.57, the provider owes ODM a total of $708,998.16.

Auditors tested aides for compliance with Medicaid requirements and identified a total of 62 services provided by aides that were ineligible to render services. One aide failed to obtain first aid certification, while two others had lapses in the certification at some point during the examination period. In addition, six aides in 2012 and seven in 2013 did not complete the required 12 hours of in-service continuing education.

“The well-being of patients should be the priority of every Medicaid provider,” Auditor Yost said. “This one jeopardized the health of those in its care by allowing unqualified employees to provide medical services.”

During a review of service authorization for 578 state plan services, auditors discovered that the claims for 188 services were submitted for reimbursement before a physician signed the plans of care. The examination also identified six services that had no plans of care and 39 services with plans of care that were not signed and/or dated by a physician.

Additionally, the auditors examined service documentation and found the following 72 errors:

Service documentation for 50 personal care aid/waiver nursing services was not signed by the recipients or authorized representatives;

15 services lacked supporting documentation; and

The units reimbursed for seven services did not agree with those listed on the service records.

The Auditor of State’s office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,800 state and local government agencies. Under the direction of Auditor Dave Yost, the office also provides financial services to local governments, investigates and prevents fraud in public agencies and promotes transparency in government.